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KMID : 0350519940470020801
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Journal of Catholic Medical College
1994 Volume.47 No. 2 p.801 ~ p.809
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Clinical Significance of Instant Nutritional Score for the Prognosis of Critically Ill Surgical Patients
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Abstract
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The critically ill surgical patients with multiple trauma or complications after extensive cancer surgery are prone to be malnourished because of the catabolic pattern as well as of the catabolic pattern as well as of limited supplies of energy
and
untrients. Because the prognosis of these patients is closely related to nutritional status, it is important to have a reliable, useful and easy method of nutritional assessment for prediction of prognosis and proper management of the patients.
To examine the prognostic value of instant nutritional score(INS), 39 cases of critically ill surgical patients were evaluated retrospectively, who had had more than one organ failures and also received nutritional support(NS), either enteral
and/or
parenteral route(s). Clinical patterns are 5 cases of adult respiratory distress syndrome, 8 cases of hepatic failure, 2 acute renal failures and 24 multiple organ failures. Various anthropometric, visceral proteins and other nutritional
parameters
are
evaluated during the periods, and were compared between those of survivors(n=29) and of failures to recover(n=10). INS is defined: 1, if albumin(Alb), transferrin and total lymphocyte count (TLC) are greater than 3.5g/100ml, 200mg/100 ml and
1,500
cell/μl respectively. 2, if Alb is above 3.5, but one of transferrin or TLC is less than the level. 3, if Alb is above, but both others are below, or Alb is lower but others are above. 4, if Alb and one of the others are below. 5, if all three
are
below the levels.
@ES The results were as follows;
@EN 1. The patients with NS from preoperative or early postoperative period(within 5 days after surgery) showed higher survival rate(94.7%) than those from late postoperative period(55.0%)(p=0.013).
2. The mean values of Alb(2.47±0.29 vs. 3.35±0.57), transferrin(91.2±34.9 vs. 147.9±57.7) and TLC(990.5±744.1 vs. 1926.8±1015.4) were significantly different between treatment failures vs. Survivors(p<0.01).
3. The survival rates of INS 1, 2, 3, 4 and 5 were 100, 100, 75, 70, and 57% respectively. The correlation of these values was highly significant(r=-0.962, p=0.009).
In conclusion, INS based on the levels of Alb, transferrin and TLC seems to be a reliable predictive nutritional index for the prognosis. INS 3 or more are regarded as needing perioperative nutritional support in critically ill surgical patients.
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